Docstoc

Download Registration and Reservation Form - HOTEL RESERVATION FORM

Document Sample
Download Registration and Reservation Form - HOTEL RESERVATION FORM Powered By Docstoc
					                        The 6th Congress of the Lebanese Society of Urology
                                September 30 – October 2, 2010.


                REGISTRATION & RESERVATION FORM
Ki ndly fill in this form, and mail or send i t by fax to INFOMED INT’L FOR EVENTS
Phone: 961-1-510881-2-3, Fax: 961-1-482116, E-mail: infomed@infomedweb.com, online submission:
www.infomedweb.com

IDENTIFICATION:

Family Name: _________________________ First Name: _______________________________
Specialty: ____________________________Hospital or Institute: _________________________
Address: _______________________________________________________________________
City_________________________________Country:___________________________________
Phone:_________________________________Fax:_____________________________________
E- mail:_____________________________ Postal Code: _________________________________

ACCOMPAYING PERSON (S) :
Family Name                                                     First Name                             Chil d
1-
2-

REGISTRATION FEES :

Member of Lebanese Society of Urolog y                   70 US $
Non member                                              250 US $
Residents                                                35 US $

Fees for Partici pants & Staff includes:
Congress bags, all scientific sessions, lunches and coffee breaks, welco me reception, e xh ibit ion entrance.

GALA DINNER:                                  75 US $


ACCOMMODATION

Date of Arrival: _______________ Time : _________________ Flight nub: ________________
Date of Departure: _____________ Time: _________________ Flight nub: _________________

Transfer with Meet & Assist and drop off: 66 US $ / per person       nbr of persons           Total:

HOTEL                   Category&               Room          Rate S GL            No of    RATE           No of    Total
                        Location                Type                               Nights   DBL/TWN        Nights
Le Royal                5 * Congress venue      Standard      $ 190                         $ 200                   $
Portemilio              5*                      Standard      $ 155                         $176                    $
Acropolis               4*                      Standard      $ 80                          $ 90                    $

* Rates are on Bed & Breakfast bases per night, subject to 10 % VAT.



GRAND TOTAL:

				
DOCUMENT INFO